Distinctive Electrophysiological Properties of Pulmonary Veins in Patients With Atrial Fibrillation

Abstract

Background— Atrial fibrillation (AF) is frequently initiated from pulmonary veins (PVs), but little is known of the electrophysiological properties of PVs. Methods and Results— Two groups were studied: 28 patients (49±13 years old) with paroxysmal AF and 20 control patients (49±14 years old) without AF. Effective and functional refractory period and conduction time from PV to left atrium (LA) were compared in the 2 groups by use of programmed stimulation with a single extrastimulus in the PVs and LA. In the AF group, the venous effective refractory periods (ERPs) were shorter than that of the LA: 185±71 versus 253±21 ms, P <0.001, whereas in the control group, they were longer (282±45 versus 253±41 ms, P =0.009). The venous ERPs and functional refractory periods in patients with AF were also shorter than that observed in control subjects (185±71 versus 282±45 ms and 210±77 versus 315±43 ms, respectively, P <0.001), whereas LA ERPs were not significantly different. Decremental conduction in PVs was more frequent (93% versus 56%, P =0.01) and had a greater increment (102±65 versus 42±40 ms, P <0.001) in patients with AF. Finally, AF was more frequently induced when pacing was performed in PVs (22 of 90) versus LA (1 of 81) in patients with AF ( P <0.001). Conclusions— The PVs of patients with AF exhibited distinctive electrophysiological properties, which were strikingly different from those of patients devoid of AF, potentially explaining their arrhythmogenicity.